Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion

Sasaki, Isao; Imahori, Taichiro; Yano, Taka-aki; Gomi, Masanori; Kuroda, Junko; Kobayashi, Norikata; Sato, Kimitoshi; Niwa, Yoji; Iwasaki, Koichi; Hasegawa, Hiroshi

doi:10.1016/j.radcr.2022.03.023

Cited by 8 publications

(11 citation statements)

References 19 publications

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“…This case highlights the diagnostic utility of angiographic findings during stent retriever deployment to recognize the underlying dissection. Our previous studies have shown that angiographic images during stent retriever deployment can provide useful information [17] , [18] , [19] , [20] . Even if recanalization is not achieved after the procedure, the occlusion characteristics can be evaluated based on the temporary restoration of blood flow during stent retriever deployment ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Acute internal carotid artery occlusion due to dissection of the paraclinoid segment: Diagnostic usefulness of angiographic findings during stent retriever deployment

Sasaki

Imahori

Yano

et al. 2023

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Acute internal carotid artery occlusion due to dissection of the paraclinoid segment: Diagnostic usefulness of angiographic findings during stent retriever deployment

Sasaki

Imahori

Yano

et al. 2023

Radiology Case Reports

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“…The DSR approach has been reported through case reports of patients treated for refractory anterior circulation occlusions[1, 3, 4, 8, 11] and in rare cases of posterior circulation occlusion. [10] DSR was first reported as a rescue technique in three consecutive, retrospective patient cohorts, two single center trials comprising 28 and 10 patients, respectively[6, 5] and one multicenter study of 20 patients.…”

Section: Discussionmentioning

confidence: 99%

“…A multicenter analysis of DSR clinical cases has indeed shown that the choice of SR size influences the effectiveness of MTB, but that large diameter SRs lead to more hemorrhagic complications. [2] However, further studies are needed to evaluate the precise effect of the DSR on arterial walls during MTB, e.g., using histological analyses in animal models as discussed by Nogueira et al [15] The DSR approach has been reported through case reports of patients treated for refractory anterior circulation occlusions [1,3,4,8,11] and in rare cases of posterior circulation occlusion. [10] DSR was first reported as a rescue technique in three consecutive, retrospective patient cohorts, two single center trials comprising 28 and 10 patients, respectively [6,5] and one multicenter study of 20 patients.…”

Section: Discussionmentioning

confidence: 99%

“…A mechanical thrombectomy (MTB) technique using a double stent retriever (DSR) has been recently reported as a successful approach to treat patients suffering from an acute ischemic stroke (AIS) due to the occlusion of a large vessel of the anterior circulation. [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12] Compared with a single stent retriever (SSR) technique, a DSR would ensure a larger metal surface interacting with the clot and an associated pincer effect, thus increasing the odds of successful capture. On the other hand, such an approach would lead to a greater force exerted by the two SRs over the vessel wall, potentially increasing the risks of vessel damage.…”

Section: Introductionmentioning

confidence: 99%

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Benchtop evaluation of a double stent retriever thrombectomy technique for acute ischemic stroke treatment

Hofmeister

Bernava

Rosi

et al. 2022

Preprint

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Background A mechanical thrombectomy technique using a double stent retriever (DSR) approach has been reported for the treatment of patients with acute ischemic stroke. The purpose of this study was to perform a benchtop evaluation of the mechanism of action and efficacy of a DSR approach compared to a single stent retriever approach. Methods In vitro mechanical thrombectomy procedures were performed in a vascular phantom reproducing a M1-M2 occlusion with two different clot analog consistencies (soft and hard). We compared the DSR approach to the single stent retriever approach and recorded the recanalisation rate, distal embolization, and retrieval forces of each mechanical thrombectomy procedure. Results The DSR approach achieved a higher recanalization rate and lower embolic complications compared to the single stent retriever approach. This seems to stem from two facts: the greater probability of targeting the correct artery with two stents in the case of bifurcation occlusion, and an improved clot capture mechanism using the DSR approach. However, the DSR was associated with an increased initial retrieval force. Conclusions In vitro evaluation of the mechanism of action of the DSR provided explanations that appear to support the high efficacy of such an approach in patient cohorts and could help operators when selecting the optimal mechanical thrombectomy strategy in cases of arterial occlusions difficult to treat with a single stent retriever.

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“…the thrombus is trapped between two stents deployed in a Yconfiguration (Li et al, 2020;Jiang et al, 2021) or overlapping (Klisch et al, 2015;Asadi et al, 2016;Sasaki et al, 2022) (for one vessel or arterial bifurcations, respectively). After the integration of the thrombus, both stents are pulled out together.…”

Section: Introductionmentioning

confidence: 99%

Parallel stent retriever mechanical thrombectomy of an acute internal carotid artery occlusion refractory to standard techniques: A case report

Yoshimoto

Hosoki²,

Tanaka³

et al. 2023

Front. Stroke

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Although mechanical thrombectomy for acute large vessel occlusion is generally effective, some occlusions are refractory. We report a patient in whom the parallel stent retriever technique using two Trevo stent retrievers (Stryker Neurovascular, Fremont, California, USA) was required to treat an intracranial and epidural internal carotid artery occlusion after other techniques had failed. A 68-year-old woman presented with an acute left internal carotid artery occlusion 4 days after mechanical thrombectomy of a left middle cerebral artery occlusion. She was not a candidate for intravenous thrombolysis because of a recent cerebral infarction. Attempts at mechanical thrombectomy using a stent retriever, contact aspiration, or combined contact aspiration and stent retriever were unsuccessful. The parallel stent retriever technique using two 6 × 25-mm Trevo stent retrievers enabled coverage of the entire thrombus, and successful reperfusion was achieved (extended Thrombolysis in Cerebral Infarction grade 2b). After the procedure, the patient was able to walk without assistance. Her modified Rankin Scale score was 2 at 90 days follow-up. Microscopic examination of the retrieved thrombi demonstrated red blood cells, fibrin, and partial endothelialization. The parallel Trevo stent retriever technique has the potential as rescue therapy for refractory large-vessel occlusion. However, complications arising from this technique remain uncertain. Further studies are needed to determine the effect of this technique in terms of recanalization and clinical safety.

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Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion

Cited by 8 publications

References 19 publications

Acute internal carotid artery occlusion due to dissection of the paraclinoid segment: Diagnostic usefulness of angiographic findings during stent retriever deployment

Acute internal carotid artery occlusion due to dissection of the paraclinoid segment: Diagnostic usefulness of angiographic findings during stent retriever deployment

Benchtop evaluation of a double stent retriever thrombectomy technique for acute ischemic stroke treatment

Parallel stent retriever mechanical thrombectomy of an acute internal carotid artery occlusion refractory to standard techniques: A case report

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